The effectiveness of midazolam as premedication for upper gastrointestinal endoscopy was examined and compared with that of diazepam in a double-blind crossover study involving 23 patients. The degree of sedation and cooperation of patients during the procedure and the speed of recovery from sedation were comparable for the two drugs. The effects of both compounds on arterial blood pressure and heart rate were quite similar. However, midazolam induced significantly more amnesia than diazepam (91% vs. 39%). Also, patients' acceptability for the procedure was significantly higher in the midazolam than in the diazepam group (78% vs. 26%). Therefore, when amnesia is desirable, as in the case of repeated endoscopies, midazolam should be the drug of choice.

Adult↗

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Preparation, premedication and surveillance.

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Anesthesia, Local↗

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Combined ranitidine and pirenzepine in the treatment of duodenal ulcer: a multicentre double-blind study using endoscopy.

The efficacy of a combination of ranitidine and pirenzepine in the short-term treatment of duodenal ulcer was evaluated in a double-blind trial. In a multicentre study, 352 patients with active duodenal ulcers were randomly allocated to be treated with 300 mg/day ranitidine plus placebo (group I), 300 mg/day ranitidine plus 50 mg/day pirenzepine (group II), or 300 mg/day ranitidine plus 100 mg/day pirenzepine (group III) for 4 weeks. The respective healing rates assessed using endoscopic examination after 2 and 4 weeks' treatment were 40% and 70% in group 1, 44% and 82% in group II, and 37% and 77% in group III. The differences between the treatment groups were not significant, although 300 mg/day ranitidine plus 50 mg/day pirenzepine tended to be superior to the other treatments. Analgesic activity was the same in the three groups with 33%, 34% and 33% reductions, respectively, in the numbers of patients experiencing pain after 2 weeks. Side-effects (mainly dry mouth and blurred vision) were significantly more frequent in group III patients.

Adult↗

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Prescribing policy for antiulcer treatment in the elderly.

In the short and long term treatment of peptic ulcer in the elderly some problems have yet to be resolved, mainly concerning the physiology and pathophysiology of the aging stomach, the pharmacokinetic and pharmacodynamic properties of antiulcer drugs, and the presence of different risk factors compared with young patients. The available data from controlled trials of peptic ulcer in the general population and from the limited experience in geriatrics, show that the clinical efficacy and tolerability of the anti-secretory drugs (e.g. cimetidine, ranitidine and famotidine) and of cytoprotective compounds are similar to that observed in younger patients. However, more data are necessary concerning the optimal dosage in relation to physiological age-related changes of liver and kidney function, the duration of prophylactic treatment, and importantly, the assurance of adequate patient compliance.

Adult↗

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Short and medium-term influence of physical activity on immune parameters.

Physical stress induces different changes in immune parameters depending on effort schedule and/or customary physical training. The mechanisms whereby they take place and the occurrence of possible tolerance after repeated effort have not been conclusively elucidated. We studied short and medium-term exercise-induced changes in immune parameters after a standard physical effort (24' of cycle ergometer up to the 80% of maximal heart rate, daily for 5 days) in a group of healthy untrained controls. White Blood Cells, lymphocyte subsets, plasmatic catecholamine and cortisol levels, IgG and IL2receptor (IL2R) levels were determined. Most of the observed changes were strictly acute effort-related and disappeared within 3 hours (except for shifts in CD4+ CD45RA+ and CD4+ CD45RA- lymphocytes): they were concomitant to a transient sympathetic activation proved by heart rate (HR) and Norepinephrine (NE) increase. The medium-term effects of repeated daily effort included only a questionable rise in CD19+ and CD3+ CD4- CD8- cells. As far as possible tolerance mechanisms are concerned, we did not detect any change in either the direction or the entity of effort-induced changes in our controls after repeated effort. Study of strictly standardized exercise protocols is mandatory before clinical applications of physical activity in the approach to the treatment of disimmune diseases.

Adult↗

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Clinical and gastroscopic evaluation of amtolmetin guacyl versus diclofenac in patients with rheumatoid arthritis.

AIM: Amtolmetin guacyl (2-[2[1-methyl-5-(4-methylbenzoyl) pyrrol-2-yl] acetamido] acetic acid 2-methoxyphenyl ester) is a recently developed drug which, in preliminary studies, has shown effective anti-inflammatory properties with improved gastrointestinal safety. Our study was designed to investigate the efficacy and tolerability of amtolmetin guacyl 600 mg bid when compared to diclofenac 50 mg tid for 4 weeks. PATIENTS AND METHODS: A total of 64 patients aged 18-80 years, suffering from rheumatoid arthritis for more than 6 months and American Rheumatism Association functional class I, II or III were randomized in a double blind manner to amtolmetin guacyl or diclofenac for 4 weeks. Clinical and endoscopic evaluation were performed at baseline and at the end of the treatment. The mucosa was graded by means of a rating system emphasizing mucosal erosions. Only patients with endoscopy grade 0-1 entered the trial. RESULTS: The median post-treatment endoscopy injury scores were 0 (range 0-4) in the amtolmetin guacyl-treated patients and 2 (range 0-4) in the diclofenac-treated patients (p = 0.005). There were nine gastric ulcers: 1/32 (3%) in the amtolmetin guacyl group and 8/32 (25%) in the diclofenac group (p < 0.05; 95% confidence interval, -30-5%). 16/32 (50%) patients in amtolmetin guacyl group and 8/32 (25%) in diclofenac group had normal gastroduodenal findings (score = 0) (p < 0.05; 95% confidence interval, 5-50%). In patients with a history of peptic ulcer, a recurrence of gastric damage (score 3-4) was observed in 18% in the amtolmetin guacyl and in 53% in the diclofenac group (p < 0.05). The incidence of gastrointestinal symptoms did not differ in the two groups. Amtolmetin guacyl significantly reduced the number of swollen and painful joints, and the functional disability index; diclofenac significantly reduced the number of painful joints and the functional disability index score (p = ns). CONCLUSIONS: Amtolmetin guacyl effectively controlled the symptoms of rheumatoid arthritis, with very limited gastric toxicity. If these findings are confirmed on a wider scale, the drug might become a valid alternative to current therapies, especially for patients at risk, such as those with rheumatoid arthritis simultaneously requiring steroids and second-line drugs, or those with a history of peptic ulcer.

Adolescent↗

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[Campylobacter pylori and pathology of the gastro-duodenal mucosa. Critical review of clinico-experimental and therapeutic contributions].

Over the past five years, a series of important contributions have appeared in the medical literature on the role of infective agents in the pathogenesis of gastric and duodenal inflammation. The analysis of the available data confirms the possible role of campylobacter pylori in causing acute inflammation of the type B antral gastritis, although its role in the pathogenesis of gastric and duodenal ulcer and of the socalled non ulcer dyspepsia is still doubtful. Not even the results of therapeutic contributions obtained with colloidal bismuth subcitrate and antibiotics allow a definitive orientation. It has not yet been possible to establish a sure correlation between the sterilization of the gastric or duodenal mucosa and the evolution of ulcer disease.

Anti-Bacterial Agents↗

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